Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.95 / $46.62 / $72.01	Facility	26	$35.95	$46.62	$72.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.92 / $147.82 / $543.87	Professional		$112.92	$147.82	$543.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.95 / $50.52 / $175.39	Professional	26	$35.95	$50.52	$175.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.97 / $98.85 / $208.15	Professional	TC	$76.97	$98.85	$208.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $227.03 / $227.03 / $276.55	Professional		$227.03	$227.03	$276.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.30 / $52.88 / $90.65	Professional	26	$42.30	$52.88	$90.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.94 / $135.61 / $201.69	Professional		$45.94	$135.61	$201.69
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $179.53 / $277.45 / $326.42	Professional		$179.53	$277.45	$326.42
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $50.80 / $50.80 / $54.94	Professional	26	$50.80	$50.80	$54.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.47 / $199.29 / $349.59	Professional		$138.47	$199.29	$349.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.70 / $68.64 / $112.96	Professional	26	$46.70	$68.64	$112.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.04 / $138.41 / $233.34	Professional	TC	$93.04	$138.41	$233.34
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $132.57 / $272.41 / $272.41	Facility	26	$132.57	$272.41	$272.41
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,809.00 / $1,809.00 / $1,809.00	Professional		$1,809.00	$1,809.00	$1,809.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $543.00 / $543.00 / $543.00	Professional	26	$543.00	$543.00	$543.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,266.00 / $1,266.00 / $1,266.00	Professional	TC	$1,266.00	$1,266.00	$1,266.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $99.00 / $281.27 / $572.25	Professional		$99.00	$281.27	$572.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.68 / $95.85 / $214.80	Professional	26	$76.68	$95.85	$214.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $166.75 / $208.43 / $467.08	Professional	TC	$166.75	$208.43	$467.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $67.42 / $188.58 / $352.24	Professional		$67.42	$188.58	$352.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $139.99 / $211.17 / $349.59	Professional		$139.99	$211.17	$349.59
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.52 / $73.34 / $115.43	Professional	26	$47.52	$73.34	$115.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $98.09 / $152.94 / $233.34	Professional	TC	$98.09	$152.94	$233.34
United Facility/Professional Professional Modifier Low / Median / High Price $146.09 / $181.05 / $273.92	Professional		$146.09	$181.05	$273.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.22 / $57.52 / $90.23	Professional	26	$48.22	$57.52	$90.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.87 / $122.34 / $196.59	Professional	TC	$97.87	$122.34	$196.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $145.49 / $163.21 / $231.44	Professional		$145.49	$163.21	$231.44
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $45.83 / $52.88 / $72.93	Professional	26	$45.83	$52.88	$72.93
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $99.66 / $110.33 / $158.52	Professional	TC	$99.66	$110.33	$158.52